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Decline Coronavirus (COVID-19) Vaccination

Please complete this form if you have received an invitation for your coronavirus (COVID-19) vaccination but do not wish to be vaccinated.

Decline Coronavirus (COVID-19) Vaccination
This will allow us to locate you quickly on our Patient Database
You will find this on your invitation letter. e.g. 52987

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All Information submitted through secure forms is secured with a private key and is accessed over a secure connection by nominated staff. We have a strict confidentiality policy.

This information is not shared with any third party organisations.

This information is retained for up to 28 days.

Learn more about our Privacy Policy and Terms of Use. Should you have any concerns about sending your personal details using the web, please use one of the alternative methods offered by our organisation.


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